The Health Care Bill has passed...

[AGDee]

I think that without a public option, the whole thing is useless. I will still have no choice. In my perfect world, health insurance being provided by an employer would be completely eliminated. They don't cover my car insurance, life insurance or home owners insurance. I don't want them handling my health insurance either. I would like an opportunity to opt out of my insane HMO and get some real insurance where I can have the doctors of my choosing. Right now, if we are covered by a spouse, we can opt out and we get $500. They PAY around $11K for each employee. I want to be able to opt out and get that whole amount from them to buy my own insurance. This bill is not "reform".

[Kevin]

Originally Posted by AGDee

I think that without a public option, the whole thing is useless..

Don't worry. If these for-profit companies do what for-profit companies have done lately (focus on the short-term gains), then a public option won't be far off. If they do what I suspect they'll do and take us all to the cleaners, Congress is going to have to step in and do something. The only thing I can see hindering them in that regard is the 15% cap on administrative costs.

I don't think it's a question if 'if,' though, but rather 'when' the private companies wear out their welcome.

[AXiDTrish]

I work for a health insurance company, albeit a smaller one (not an Aetna or United), and believe me we are NOT rolling in dough. Our benefits are less then many of the groups we cover and we as employees have the same concerns about our employment as other companies. Insurance companies aren't innocent by any means, but they aren't all bad either.

What infurates me:

1. Ambulance chasing lawyers and their frivolous, ridulous law suits!
2. Collections agencies that buy accounts from doctors who have left their practice and then collect inappropriately! Seriously, I really hate collectors!
3. Doctor's and hospitals who think they should be paid astronomical amounts. I definitely think they should be paid fairly, but for Pete's sake, just because you went to medical school doesn't mean your entitled to a fortune! DISCLAIMER: This does not apply to every doctor, but there are some doozies out there who have enormous ego's and are total a$$holes!

[AOII Angel]

Originally Posted by AXiDTrish

I work for a health insurance company, albeit a smaller one (not an Aetna or United), and believe me we are NOT rolling in dough. Our benefits are less then many of the groups we cover and we as employees have the same concerns about our employment as other companies. Insurance companies aren't innocent by any means, but they aren't all bad either.

What infurates me:

1. Ambulance chasing lawyers and their frivolous, ridulous law suits!
2. Collections agencies that buy accounts from doctors who have left their practice and then collect inappropriately! Seriously, I really hate collectors!
3. Doctor's and hospitals who think they should be paid astronomical amounts. I definitely think they should be paid fairly, but for Pete's sake, just because you went to medical school doesn't mean your entitled to a fortune! DISCLAIMER: This does not apply to every doctor, but there are some doozies out there who have enormous ego's and are total a$$holes!

I think this is a rarity. Doctors are generally paid an average across an area. We can bill whatever we want, but the insurance companies pay what they have set as the fee for service. Don't forget that the amount that is collected by a physician doesn't all go to the physician, also. For most physicians, this pays for their overhead, including office space, staff, insurance for their staff, medical liability insurance, etc. before it goes towards a physician's salary. For example, a surgeon can spend three hours doing a sigmoid colectomy for colon cancer. He/she will be reimbursed less than $3000 for the procedure which includes the surgery and 3 months of follow-up care including any complications. That is very little money for the time involved, not to mention the education or the 6 years of residency at 100+ hours/week of near slave labor. There are very few specialties in medicine where a doctor can make a fortune anymore....most don't involve insurance companies! Before you blame your doctor for the state of medicine, stop and ask yourself how much you'd want to be compensated for 20 years of education and a minimum of 3 years of post-graduation apprenticeship with up to 80 hours/wk (now regulated by the federal government) work hours for about $6 an hour just to work 70-90 hour work weeks when you go into private practice? Some physicians barely make $90,000 a year and have over $100,000 in student loans. I'm lucky to have picked a field with a shortage of physicians that has a growing need and good reimbursement, but who knows how long that will last. I'm compensated because no one else can do the job I do.

[AXiDTrish]

I'm not placing a blame game on all doctors. This healthcare mess is not a fault of theirs. They are a cog in a very large wheel. Like I said in m,y disclaimer, a FEW doctor's think they should be paid above and beyond all others. Most do not. Certainly every office manager/administrator believes their doctor is the absolute best in the state!

You are correct, doctors do get paid a percentage based on their area. Medicare reimbursement is generally used as the base (which is a scary place to start considering how they pay!) and a doctor's fee's are dependant upon how they negotiate with the insurance company. Usually, the more providers in a group, the more negotiating strength they have.

[Kevin]

Originally Posted by AXiDTrish

1. Ambulance chasing lawyers and their frivolous, ridulous law suits!

As an 'ambulance chasing lawyer,' (yes I do personal injury, but not medical malpractice), I cannot actually recall even hearing about a so-called frivolous lawsuit anywhere but in the national media; and even then, I can't recall a story which was in my opinion actually frivolous other than the lawsuit filed by that former Administrative Law Judge in D.C. regarding his alleged lost pants.. (and his case was dismissed with prejudice, he was disbarred and a judgment was granted against him for attorneys fees).

Other than that, there is simply no basis for saying that if frivolous lawsuits do exist, that said lawsuits are actually a serious problem in the grand scheme of things.

And if you're really looking for the culprit in all of this, look at the doctors. Depending on the study you're looking at, medical errors account for between 98,000 and 195,000 deaths per year. And no one, not even the insurance companies which deny claims for malpractice and subsequently force and lose a lot of trials would tell you (unless they were telling lies) that the majority or even close to a significant number of lawsuits are frivolous.

[AOII Angel]

Originally Posted by Kevin

As an 'ambulance chasing lawyer,' (yes I do personal injury, but not medical malpractice), I cannot actually recall even hearing about a so-called frivolous lawsuit anywhere but in the national media; and even then, I can't recall a story which was in my opinion actually frivolous other than the lawsuit filed by that former Administrative Law Judge in D.C. regarding his alleged lost pants.. (and his case was dismissed with prejudice, he was disbarred and a judgment was granted against him for attorneys fees).

Other than that, there is simply no basis for saying that if frivolous lawsuits do exist, that said lawsuits are actually a serious problem in the grand scheme of things.

And if you're really looking for the culprit in all of this, look at the doctors. Depending on the study you're looking at, medical errors account for between 98,000 and 195,000 deaths per year. And no one, not even the insurance companies which deny claims for malpractice and subsequently force and lose a lot of trials would tell you (unless they were telling lies) that the majority or even close to a significant number of lawsuits are frivolous.

From personal experience, I can say that there are frivilous lawsuits. I think there are lawyers who do NOT cross their "T"s and dot their "I"s. Doctors aren't the only ones who make mistakes. Medical errors do occur because doctors are humans, nurses are humans, information is misinterpreted, but not all medical errors are malpractice. Unlike doctors, though, we can't sue lawyers for malpractice.

I was sued for malpractice for a case which did involve malpractice by another set of physicians. I was said to be incapable of performing cataract surgery, providing anesthesia and a whole host of medical procedures that I do NOT perform simply because my name was on a chart. It took two years and a lot of money to get my name removed from the lawsuit that should never have included my name in the first place. I can also name at least three other people at the same institution named in the same case who were also not involved in the inciting incident. Multiple other people have been named in cases inappropriately. You multiply this by every malpractice suit in the nation, and you can't convince me that this does not influence the cost of malpractice insurance which most definitely does increase the cost of health care.

Malpractice suits definitely have their place. I can think of a number of cases off the top of my head from residency that I could even testify for the patient. The case above had merit and settled for an undisclosed amount. I just wish all lawyers would practice due diligence before filing these cases.

That being said, lawsuits are NOT the problem with health care, but they do drive doctors to practice "cover your ass" medicine which has driven up the cost of health care significantly.

[kddani]

Originally Posted by AOII Angel

Unlike doctors, though, we can't sue lawyers for malpractice.
...
I just wish all lawyers would practice due diligence before filing these cases.

[disclaimer] Yes, I am an attorney, but I've handled only one med mal case in my life and that was defending a doctor sued by a prison inmate on what I would agree was a frivolous case (like quite a few prisoner cases)[/disclaimer]

Point 1- Attorneys are often sued for malpractice.

Point 2 - Lawyers should practice due diligence before filing the cases. For instance Pennsylvania has particular standards that must be met when filing a med mal case, which generally require that a Certificate of Merit be filed with the Complaint certifying a qualified expert has supplied a written statement that there exists a reasonable probability that the defendant's care fell outside acceptable professional standards and that such conduct was a cause of injury.

Also, sometimes lawyers simply cannot obtain the information that they need before filing a complaint against a party or parties. With some information, there is no way to get it from the defendants until the parties are engaged in litigation.

This is more directed at AXiDTrish, but I agree that there are frivolous lawsuits, however, if a judge or jury finds in favor of a Plaintiff and awards damages, then that lawsuit can hardly be said to be frivolous. And capping them is a huge issue - damages are on a case by case basis. If you ever lost a loved one or incurred a grave harm, wouldn't you be pissed that some random politician told you how much you could recover?

Also to AXiDTrish, what do debt collectors have anything to do with this discussion? Why don't doctors (or anyone else) have a right to collect money owed to them? If anything, the collection of debt HELPS the industry by increasing the percentage of fees recovered. I don't agree with illegal debt collection practices, but there are plenty of statutes in place (both on a federal and state level) that protect against that (and provide with some interesting penalties).

[AOII Angel]

[QUOTE=kddani;1878843]

Point 1- Attorneys are often sued for malpractice.

Yeah, but I can't sue an attorney for suing me frivilously, wasting my time and money when I had nothing to do with a case. Also, you have to get a lawyer to sue the other lawyer...I have a feeling that's kinda like getting a doctor to testify against another doctor!

In thhe case in question, they had enough information to know that I was the resident who had read the CT Brain on the patient after she had coded, but they did NOT sue the anesthesiologists or the ophthalmologists who were present when the patient coded and basically became brain dead. The whole case was ridiculous from the start. Every person listed on the complaint actually helped the patient after the incident and got slapped with the lawsuit for our trouble.

[Kevin]

Originally Posted by AOII Angel

From personal experience, I can say that there are frivilous lawsuits. I think there are lawyers who do NOT cross their Ts and dot their Is. Doctors aren't the only ones who make mistakes. Medical errors do occur because doctors are humans, nurses are humans, information is misinterpreted, but not all medical errors are malpractice. Unlike doctors, though, we can't sue lawyers for malpractice.

True, errors are not malpractice unless you violate the applicable standard in your jurisdiction for malpractice. But malpractice does happen. The solution should involve targeting doctors who are repeat offenders for termination of their licenses, the prompt payment of claims which obviously involve malpractice, and a fair and just manner of scheduling compensation for victims so that the respective parties would at least have some sort of legal guidelines in settling claims.

From a lawyer's perspective, it is very difficult to properly evaluate a case before even getting to the first settlement demand. The client comes into your office, tells you her 'tale of woe,' and that's all you have to go on until you submit the case to an expert for evaluation. Often in the meantime, you'll have a deadline or a statute of limitations issue and have to file your case just to avoid that deadline (be it a winner or not, because contrary to your assertion, failure to do so could result in a malpractice case being brought against the attorney).

Compound that with the fact that in jurisdictions like Oklahoma, it costs the attorney (who usually foots the bill because sick/injured/dead people can't usually afford justice) a minimum of $5,000 for an expert's opinion just to file the case. Note that at least around here, we only have one malpractice insurer. That insurer will not insure any doctor who testifies or signs an affidavit against another doctor, so we either have to go out of state or go to a professional 'hired gun.' Getting a real, honest assessment of the case is damn near next to impossible.

As for something being 'frivolous,' while to you, it might appear to be frivolous, the attorney simply can't in all cases properly evaluate the case without first getting something filed and taking depositions and conducting discovery. He can't do that without shelling out some serious coin of his own to do so. So if you mean frivolous as in 'bad faith,' I'll bet that the number of those cases being filed is damn next to nil. But of course, just like with any other tort law, some losing cases will get filed. If the case does make it to trial, however, it cannot be said to be frivolous at all -- there are a lot of mechanisms preventing truly frivolous claims from making it to that stage and I'm convinced they work very well -- sometimes too well.

One of the conclusions of this 2006 study was that ". . .the number of meritorious claims that did not get paid was actually larger than the group of meritless claims that were paid." So who really should have more protections in the legal system? The folks who are killing and maiming through their negligence? Or the folks who are killed and maimed? Right now, clearly, the killers and maimers are better protected and are demanding more protection. I guess money talks.

http://www.hsph.harvard.edu/news/pre...s05102006.html

I was sued for malpractice for a case which did involve malpractice by another set of physicians. I was said to be incapable of performing cataract surgery, providing anesthesia and a whole host of medical procedures that I do NOT perform simply because my name was on a chart. It took two years and a lot of money to get my name removed from the lawsuit that should never have included my name in the first place. I can also name at least three other people at the same institution named in the same case who were also not involved in the inciting incident. Multiple other people have been named in cases inappropriately. You multiply this by every malpractice suit in the nation, and you can't convince me that this does not influence the cost of malpractice insurance which most definitely does increase the cost of health care.

Oh, absolutely, I agree with you here. The administrative and litigation costs in settling malpractice claims are absurd. Unfortunately, both sides only favor outcomes which clearly stack the deck in their favor. For example, the insurance/physicians side wants to place hard caps on pain and suffering awards -- something which not only is morally objectionable in that it places a monetary value on human life, telling doctors and insurance companies when it's okay just to make a business decision and intentionally kill someone or maim them, it also disproportionately harms the most grievously injured patients by not affording them a proper level of compensation for their injuries.

Some things I'd possibly be in favor of (depending on the setup) would be accelerated discovery schedules, faster court dates, judges with medical expertise who are better equipped to wade through fact-intensive pretrial motions, etc. I had a friend of mine (a doctor) go through exactly the same thing. Didn't cost him a penny of course, just a lot of stress. That's why we have malpractice insurance. Turns out that the case (wasn't even that good a case) was filed by the attorney simply because the statute of limitations was about to expire and he had to get something filed to avoid malpractice on his own part. That stuff happens -- and when you have a client/victim who has twelve doctors on his charts, it's impossible, possibly even malpractice not to name every single one of them without knowing *precisely* what their involvement in the case was... and charts can be wrong.

I just wish all lawyers would practice due diligence before filing these cases.

I think in most cases, they do. In other cases, the client doesn't show up until the statute of limitations is looming and you have to get something filed to cover the bases. Still, in other cases, you really can't start to exclude innocent doctors from the case until you've had an opportunity to conduct discovery. Sometimes, due diligence doesn't happen until after the case gets filed because it simply cannot.

That being said, lawsuits are NOT the problem with health care, but they do drive doctors to practice "cover your ass" medicine which has driven up the cost of health care significantly.

I'm not sure that's a bad thing though. Docs wouldn't be doing that if the risk/reward calculus for practicing that sort of medicine didn't come out in their favor. They obviously must know that doing that means that they are operating at the standard of care and that it is more likely to save lives or prevent injuries to patients.

[KSig RC]

Originally Posted by AOII Angel

From personal experience, I can say that there are frivilous lawsuits.

MedMal lawyers will tell you: about one case in a thousand has enough merit to go to trial, in any shape - physicians still win the "public opinion" battle here. So yeah, while there are some "chop shop" firms, the overwhelming majority of cases are not fueled by attorneys at all. In fact, medical malpractice is likely grossly underreported, because "minor" malpractice has no recourse (trials are brutal, on the doctors, on the families, on hospitals, even on the insurance companies who need to keep a careful balance sheet to pay out all premiums paid in).

You multiply this by every malpractice suit in the nation, and you can't convince me that this does not influence the cost of malpractice insurance which most definitely does increase the cost of health care.

Studies of potential tort reform methods indicate that capping non-economic damages at $250,000 in every state that does not have such restrictions already would reduce medical malpractice premiums by a whopping . . . 8%. The problem obviously isn't verdicts.

The problems with malpractice insurance, as it relates to medical costs, are difficult to pin down - insurance companies claim the problems are "huge awards" that happen rarely in reality (and usually only for deaths/permanent disfigurement/botched births), doctors and insurers blame fear of litigation for "defensive medicine" that drives costs up across the board, attorneys blame doctors, and the consumer really doesn't care because they foot the bill either way.

Malpractice suits definitely have their place. I can think of a number of cases off the top of my head from residency that I could even testify for the patient. The case above had merit and settled for an undisclosed amount. I just wish all lawyers would practice due diligence before filing these cases.

That being said, lawsuits are NOT the problem with health care, but they do drive doctors to practice "cover your ass" medicine which has driven up the cost of health care significantly.

There are a couple of problems with this (not "logical" problems, but endemic issues as medicine and litigation interrelate):

1 - If "defensive medicine" actually does its job and reduces lawsuits (because verdicts and/or sheer number of lawsuits are the problem), then it should pay for itself, and insurers should be all for it, right?

2 - And if defensive medicine doesn't "work" (under our operating definition), then the problem is on the supply side, and not the demand side, right?

3 - Isn't one of the problems with the "system" (as it were) that you're generally discouraged from testifying in these cases you say you could have testified in? Wouldn't that drive the case to settlement/fair-value judgment much faster? Remember, the long, drawn-out process you describe earlier is only partly a product of the plaintiffs' bar (which will generally carpet-bomb with claims, then clean up the mess later once discovery begins) - the insurers, who generally take over the case from the doctor/hospital immediately, have much more to gain from a long, drawn-out process than the plaintiffs do.

I can't say this last part strongly enough: insurance companies who have taken over defense for the doctors have made an amazing mess of costs as well. Whether it is dragging discovery out for six years in a cerebral palsy birth case to get the family to "quit" or accept a favorable settlement (because of pain, needing money, private insurance reaching its cap, etc.); or calling 30 experts to testify about causation, life care exceptions, state aid or just to read an MRI (at an average of $1,000 an hour); or using the same "trial in a box" that has been used for 35 years in court - all of which actually happen in just about every botched-birth case, etc. - the attorneys from the defense side are just as much the problem.

[AOII Angel]

Originally Posted by KSig RC

MedMal lawyers will tell you: about one case in a thousand has enough merit to go to trial, in any shape - physicians still win the "public opinion" battle here. So yeah, while there are some "chop shop" firms, the overwhelming majority of cases are not fueled by attorneys at all. In fact, medical malpractice is likely grossly underreported, because "minor" malpractice has no recourse (trials are brutal, on the doctors, on the families, on hospitals, even on the insurance companies who need to keep a careful balance sheet to pay out all premiums paid in).



Studies of potential tort reform methods indicate that capping non-economic damages at $250,000 in every state that does not have such restrictions already would reduce medical malpractice premiums by a whopping . . . 8%. The problem obviously isn't verdicts.

The problems with malpractice insurance, as it relates to medical costs, are difficult to pin down - insurance companies claim the problems are "huge awards" that happen rarely in reality (and usually only for deaths/permanent disfigurement/botched births), doctors and insurers blame fear of litigation for "defensive medicine" that drives costs up across the board, attorneys blame doctors, and the consumer really doesn't care because they foot the bill either way.

I haven't proposed capping malpractice verdicts, just asking that lawyers actually check that they sue the correct physicians before they send in the paperwork. I don't like being accused of being incapable of performing procedures I didn't perform!

There are a couple of problems with this (not "logical" problems, but endemic issues as medicine and litigation interrelate):

1 - If "defensive medicine" actually does its job and reduces lawsuits (because verdicts and/or sheer number of lawsuits are the problem), then it should pay for itself, and insurers should be all for it, right?
The problem is that defensive medicine is not good for patients and is expensive which drives escalating health care costs. (Please see earlier posts)

2 - And if defensive medicine doesn't "work" (under our operating definition), then the problem is on the supply side, and not the demand side, right?
I'm not really sure what you mean by this. Ordering every test under the sun doesn't mean you are going to improve outcomes. A lot of tests have ambiguous results, lead to further tests and have complications.

3 - Isn't one of the problems with the "system" (as it were) that you're generally discouraged from testifying in these cases you say you could have testified in? Wouldn't that drive the case to settlement/fair-value judgment much faster? Remember, the long, drawn-out process you describe earlier is only partly a product of the plaintiffs' bar (which will generally carpet-bomb with claims, then clean up the mess later once discovery begins) - the insurers, who generally take over the case from the doctor/hospital immediately, have much more to gain from a long, drawn-out process than the plaintiffs do.
I have been involved in only one case where I was deposed for the plaintiff. It was in Louisiana. The medical review board (which was apparently composed of "Good Ole Boys" because this was an obvious case of malpractice) found that there was no malpractice. He decided to sue the hospital anyway, so I was deposed but it went no further. As far as I know, there is no clause in my malpractice insurance that says I can't testify against another physician. That being said, in private practice, I can know about cases but not have enough first hand knowledge to actually testify in court about them.

I can't say this last part strongly enough: insurance companies who have taken over defense for the doctors have made an amazing mess of costs as well. Whether it is dragging discovery out for six years in a cerebral palsy birth case to get the family to "quit" or accept a favorable settlement (because of pain, needing money, private insurance reaching its cap, etc.); or calling 30 experts to testify about causation, life care exceptions, state aid or just to read an MRI (at an average of $1,000 an hour); or using the same "trial in a box" that has been used for 35 years in court - all of which actually happen in just about every botched-birth case, etc. - the attorneys from the defense side are just as much the problem.
Don't get me started on cerebral palsy. This is not due to BIRTH TRAUMA. It's perinatal ischemia. OB-GYNs get so much shit for delivering babies. It is impossible to tell when the brain injury occurred unless there is a VERY WELL documented incident during the delivery. Most of the time, there isn't.

See my responses in Bold